When is prior authorization needed?
Security Health Plan requires prior authorization for some medical services or equipment. While a provider will generally make these requests and submit the necessary forms, it is a member’s responsibility to make sure the process is followed. A health care provider may contact Security Health Plan to determine whether a prior authorization is required for a member’s service or medical equipment by calling our Provider Assistance Line at 1-800-548-1224.
|Air ambulance transport||Infuse bone graft|
|Amino acid formula||Lung volume reduction surgery|
|Autologous cultured chondrocytes||MAZE procedure|
|Cardiac valve replacement||Non-affiliated provider request|
|Clinical trials||Non-emergent ambulance transport|
|Cosmetic and reconstructive surgery||Office procedure with site of service request other than in an office setting|
|Elective inpatient admission including:||Oral appliance for obstructive sleep apnea|
|Medical (acute and behavioral health)||Outpatient procedure with site of service request as inpatient setting|
|Surgical||Outpatient therapy treatment (occupational therapy, physical therapy, speech therapy)|
|Enteral feeding||Second opinion|
|Experimental or investigational services||Skin substitute|
|Fecal transplant||Spinal cord stimulation|
|Femoroacetabular impingement surgery||Swing bed admission|
|Hearing aids for members over 18 years of age||Elective outpatient procedures such as, but not limited to:|
|Home health including but not limited to:||Carpal tunnel surgery|
|Skilled nursing||Knee arthroscopy|
|Physical therapy||Back surgeries at all levels|
Durable medical equipment
All services for durable medical equipment and prosthetic-orthotic services will require prior authorization from Northwood, Inc.
Security Health Plan has partnered with Northwood, Inc., to manage all durable medical equipment and prosthetic-orthotic services. Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive. Below are a few services that require prior authorization and need follow-up with Northwood.
- durable medical equipment
- prosthetic-orthotic services
Part B drugs
Part B-covered drugs known as medical benefit drugs that are injected or infused while you are getting physician office, hospital outpatient, ambulatory surgical center or home infusion services may require prior authorization.
Home infusion drugs
Skilled nursing services that require prior authorization
acute rehabilitation admission
long-term acute care admission
skilled nursing facility admission
High-end imaging services that require prior authorization
For all high-end imaging and radiation oncology services, you will need to work with your provider to receive prior authorization from eviCore healthcare.
For high-end imaging
Fax an eviCore request form (available online) to 1-888-693-3210
For radiation oncology